Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)
Authors: Carl Thomas Anthon, Frédéric Pène, Anders Perner, Elie Azoulay, Kathryn Puxty, Andry Van De Louw, Andreas Barratt-Due, Sanjay Chawla, Pedro Castro, Pedro Póvoa, Luis Coelho, Victoria Metaxa, Matthias Kochanek, Tobias Liebregts, Thomas Kander, Johanna Hästbacka, Jo Bønding Andreasen, Edwige Péju, Lene Bjerregaard Nielsen, Christine Lodberg Hvas, Etienne Dufranc, Emmanuel Canet, Linda Lundqvist, Christopher John Wright, Julien Schmidt, Fabrice Uhel, Hafid Ait-Oufella, Mette Krag, Elisabet Cos Badia, Cándido Díaz-Lagares, Sophie Menat, Guillaume Voiriot, Niels Erikstrup Clausen, Kristian Lorentzen, Reidar Kvåle, Thomas Hildebrandt, Aleksander Rygh Holten, Kristian Strand, Asterios Tzalavras, Morten Heiberg Bestle, Pål Klepstad, Sara Fernandez, Damien Vimpere, Carolina Paulino, Carina Graça, Catherina Lueck, Christian Svendsen Juhl, Carolina Costa, Per Martin Bådstøløkken, Teresa Miranda, Lia Susana Aires Lêdo, Joao Carlos Sousa Torres, Anders Granholm, Morten Hylander Møller, Lene Russell, Ahmed Khalil, Ahmed Yehia, Haney Salem, Hesham Farahat, Manu Sudevan, Melissa Biggart, Nirmeen Fatima, Mohammed Elkhonezy, Anne-Marie Bunzel, Rine M. Siegumfeldt, Stine R. Vestergaard, Juliette Pelle, Minh-Pierre Lê, Clara Vigneron, Morgane Bertrix, Paul Cirera, Driss Laghlam, Swann Bredin, Nathalie Marin, Maria Toppenberg, Brice Benelli, Amélie Seguin, Charlotte Garret, Florian Guillotin, Gauthier Blonz, Jean-Baptiste Lascarrou, Jérémie Lemarie, Luc Desmedt, Maïté Agbakou, Mathieu Carpentier, Maëlle Martin, Naïla Benkalfate, Olivier Zambon, Paul Decamps, Pauline L. Wilquin, Soraya Benguerfi, John Gardner, Natalie Remor, Sheila Carr, Gloria Yang, Coralie Gernez, Ingrid Thiry, Louai Missri, Moritz K. G. Denneborg, Katherine Brown, Vanessa Casares, Mirka Sivula, Elina Lappi, Leena Pettilä, Jonna Heinonen, Minttu Saario, Manal K. Mecheri, Alezandre Elabbadi, Cyrielle Desnos, Antoine Lafarge, Olfa Mghirbi, Brit Å. Sjøbø, Cecilie Christoffersen, Frederik H. Bestle, Claudia Lemos, Cristiana V. Gonçalves, Nuno M. B. Jacinto, Monica P. Anselmo, Marius M. Hoeper, Marja Hoff, Pedro M. Simões Freire
Journal: Intensive Care Medicine (2023)

Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.